PMID- 29610864 OWN - NLM STAT- MEDLINE DCOM- 20190923 LR - 20210503 IS - 2168-6211 (Electronic) IS - 2168-6203 (Print) IS - 2168-6203 (Linking) VI - 172 IP - 6 DP - 2018 Jun 4 TI - Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood. PG - e180315 LID - 10.1001/jamapediatrics.2018.0315 [doi] LID - e180315 AB - IMPORTANCE: Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy. OBJECTIVE: To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted in 792 130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018. EXPOSURES: Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI), or antibiotic. MAIN OUTCOMES AND MEASURES: The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy. RESULTS: Of 792 130 children (395 215 [49.9%] girls) included for analysis, 60 209 (7.6%) were prescribed an H2RA, 13 687 (1.7%) were prescribed a PPI, and 131 708 (16.6%) were prescribed an antibiotic during the first 6 months of life. Data for each child were available for a median of 4.6 years. Adjusted hazard ratios (aHRs) in children prescribed H2RAs and PPIs, respectively, were 2.18 (95% CI, 2.04-2.33) and 2.59 (95% CI, 2.25-3.00) for food allergy, 1.70 (95% CI, 1.60-1.80) and 1.84 (95% CI, 1.56-2.17) for medication allergy, 1.51 (95% CI, 1.38-1.66) and 1.45 (95% CI, 1.22-1.73) for anaphylaxis, 1.50 (95% CI, 1.46-1.54) and 1.44 (95% CI, 1.36-1.52) for allergic rhinitis, and 1.25 (95% CI, 1.21-1.29) and 1.41 (95% CI, 1.31-1.52) for asthma. The aHRs after antibiotic prescription in the first 6 months of life were 2.09 (95% CI, 2.05-2.13) for asthma, 1.75 (95% CI, 1.72-1.78) for allergic rhinitis, 1.51 (95% CI, 1.38-1.66) for anaphylaxis, and 1.42 (95% CI, 1.34-1.50) for allergic conjunctivitis. CONCLUSIONS AND RELEVANCE: This study found associations between the use of acid-suppressive medications and antibiotics during the first 6 months of infancy and subsequent development of allergic disease. Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit. FAU - Mitre, Edward AU - Mitre E AD - Department of Microbiology and Immunology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. FAU - Susi, Apryl AU - Susi A AD - Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. FAU - Kropp, Laura E AU - Kropp LE AD - Department of Microbiology and Immunology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. FAU - Schwartz, David J AU - Schwartz DJ AD - Division of Allergy and Immunology, Department of Medicine, Dwight D. Eisenhower Army Medical Center, Ft Gordon, Georgia. FAU - Gorman, Gregory H AU - Gorman GH AD - Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. FAU - Nylund, Cade M AU - Nylund CM AD - Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. LA - eng PT - Journal Article DEP - 20180604 PL - United States TA - JAMA Pediatr JT - JAMA pediatrics JID - 101589544 RN - 0 (Anti-Bacterial Agents) RN - 0 (Histamine H2 Antagonists) RN - 0 (Proton Pump Inhibitors) SB - IM CIN - JAMA Pediatr. 2018 Oct 1;172(10):990-991. PMID: 30128543 CIN - JAMA Pediatr. 2018 Oct 1;172(10):988-989. PMID: 30128563 CIN - JAMA Pediatr. 2018 Oct 1;172(10):988. PMID: 30128565 CIN - JAMA Pediatr. 2018 Oct 1;172(10):987-988. PMID: 30128570 CIN - JAMA Pediatr. 2018 Oct 1;172(10):989-990. PMID: 30128574 CIN - J Pediatr. 2018 Nov;202:330-333. PMID: 30360873 MH - Anti-Bacterial Agents/*adverse effects MH - Child MH - Child, Preschool MH - Female MH - Gastrointestinal Microbiome/*drug effects MH - Histamine H2 Antagonists/*adverse effects MH - Humans MH - Hypersensitivity/*etiology MH - Infant MH - Infant, Newborn MH - Male MH - Proton Pump Inhibitors/*adverse effects MH - Retrospective Studies MH - Risk Factors PMC - PMC6137535 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2018/04/04 06:00 MHDA- 2019/09/24 06:00 PMCR- 2019/04/02 CRDT- 2018/04/04 06:00 PHST- 2018/04/04 06:00 [pubmed] PHST- 2019/09/24 06:00 [medline] PHST- 2018/04/04 06:00 [entrez] PHST- 2019/04/02 00:00 [pmc-release] AID - 2676167 [pii] AID - poi180013 [pii] AID - 10.1001/jamapediatrics.2018.0315 [doi] PST - ppublish SO - JAMA Pediatr. 2018 Jun 4;172(6):e180315. doi: 10.1001/jamapediatrics.2018.0315. Epub 2018 Jun 4.